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Frontline Report   |    
Employment for Persons With Borderline Personality Disorder
Beth Elliott, Ph.D.; Odile Weissenborn
Psychiatric Services 2010; doi: 10.1176/appi.ps.61.4.417
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Dr. Elliott is director of The Connections Place (TCP) of the National Education Alliance for Borderline Personality Disorder. Ms. Weissenborn was formerly communications manager at TCP. Send correspondence to Dr. Elliott, TCP, 180 W. 80th St., New York, NY 10024 (e-mail: beth@theconnectionsplace.org).

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Individuals with borderline personality disorder often face obstacles to employment. Research indicates that over 50% of individuals with the disorder are severely impaired in employability. In light of the fact that a recent National Institutes of Health study found that the lifetime prevalence of borderline personality disorder in the U.S. general population is 5.9%, there appears to be an identifiable need for vocational services to help people with this disorder.

In December 2006, under the auspices of the National Education Alliance for Borderline Personality Disorder, we initiated a job preparedness program in New York City called "The Connections Place" (TCP). Our goal is to help clients with borderline personality disorder take small steps toward employment.

TCP offers a four-month job preparedness program. Many of our clients stay longer, however, depending on their particular needs. The curriculum consists of two modules. The "portals" module teaches the skills needed to overcome the emotional obstacles related to working. These skills include increasing the motivation to work, coping with the stresses of the job application process, and managing interpersonal conflicts with colleagues and supervisors. Many of the skills are similar to those used in dialectical behavior therapy, a therapy that has been highly effective with persons with borderline personality disorder.

The "vocational" module focuses on identifying realistic and meaningful work, writing resumes, practicing interviewing skills, and completing applications for employment. This module uses elements of the "choose-get-keep" approach to employment. TCP also offers individual meetings with vocational coaches, internships, vocational assessments, computer tutorials, and presentations by invited speakers. These speakers include those who have the disorder and have successfully returned to the workplace.

To our knowledge TCP is the first of its kind in the country—a job preparedness program specifically targeted to individuals with borderline personality disorder. Our office is open two days a week. Our group meetings are convened on both days for 1.5 hours with up to ten clients in a group led by two coleaders. Clients meet individually once a week with a vocational coach to focus on specific vocational goals. In addition, clients have ample time in the office to complete job-related computer work.

To participate in the program an individual must be an adult (18 or older) and have received a diagnosis of borderline personality disorder or features of the disorder. Potential clients must also be in concurrent individual therapy. Finally, individuals seeking to enter the program must have a written agreement from their therapist in support of TCP and meet the TCP criteria of stability and absence of certain destructive behaviors. The monthly fee for attending TCP is based on a sliding scale.

Since opening in December 2006, we have had over 85 clients. Clients represent a varied work-related background, from those who have never held a job to those who have had a significant career. While at TCP, clients have found work in a number of areas, including copyediting, pet care, legal services, marketing, and public relations. Work environments include bookstores, nonprofit organizations, a bakery, and a hotel. Some TCP participants have entered training programs, colleges, or graduate school.

Most of our clients have taken steps toward employment. For example, clients have engaged in activities such as writing their first resume or improving their current resume, seeking jobs, and securing interviews. Clients report improvements in their lives, including decreased isolation, increased structure to their day, more social contacts, and greater productivity.

We believe that the TCP program fills two gaps. First, it adds another option to existing services for individuals with borderline personality disorder. Second, because TCP is currently privately funded, our program fills a void in government services. As one of our clients stated, "TCP is a bridge between therapy and work."

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